Diagnosis

Non-Surgical Diagnostic Methods

Breast Self-Examination: Starting from the age of 15, breast self-examination should be performed every month at every age. The patient should memorize the expected breast structure and consult a physician when she notices a change in breast tissue.

Breast USG (Ultrasonography): It helps to recognize the structure of the breast and the masses inside it with special sound waves. It can be easily applied at any age. Ultrasound maintains its importance as the first diagnostic method in differentiating benign and carcinogenic structures of the structures detected at all ages, especially during patient follow-up or during self-breast examination. On USG, it can be easily understood whether the structures are homogeneous or heterogeneous, whether their edges are regular or irregular, whether they gain space by pushing the surrounding tissues (in benign diseases such as fibro adenoma), or whether they invade the surrounding tissues (invasion) and disrupt their integrity. Ultrasound plays an important role in early diagnosis, as increased blood circulation in the tissue can also be detected with the method called Doppler (color ultrasound).

Mammography: It is a diagnostic method performed by taking a film of the breast with the help of X-rays. Shooting can be done starting from the age of 40. It is still used as the gold standard in the world today. It is ineffective because it cannot pass through the breast tissue. The recommended starting age for women is 40 years and above. At this age, the density and gland structure of the breast tissue decreases. It becomes more permeable to X-rays. Therefore, it is very important especially in the diagnosis and follow-up of the older age group. It is recommended once every 2 to 3 years between the ages of 40-50, once a year after the age of 50-65, and once every 2 years after the age of 65. On mammography, benign structures such as cyst fibroadenoma show themselves with smooth edges. Changes due to edema, such as fibrocystic diseases, usually cause similar findings bilaterally, since both breasts can be seen. Carcinogenic structures are generally unilateral and asymmetrical. And since they make star-like retreats after a certain size, they appear different from normal structures.

MRI: It is used for diagnostic purposes for breast tissue, especially when diagnosis cannot be made with other advanced techniques. 5mm. It seems to be effective in the diagnosis of the body and the structures on it. It is also preferred in the detection and follow-up of spreads called metastases. In this technique, a dye combined with sugar that is visible on MRI is injected into a vein. The technique is based on imaging cancer cells that are sensitive to sugar and consume more sugar than the body's normal cells.
The recommended intra-breast withdrawal time is the 5th-6th day of menstruation. 10-12 days. between day and time. Since the breast is less edematous during this period, extraction gives better results. Since it is an advanced technique, it is used in routine monitoring. It is used to identify the mass when a suspicious mass is detected. This technique is important in terms of not only showing the direct carcinogenic properties of the mass itself, but also determining the increase in the amount and rate of blood intake into the tissue, which is a decomposer for carcinogenic cells. In order for the examination to be most successful, the patient must go to the MRI fasting.
Benign structures provide blood supply on MRI. But their blood circulation rate is slow and their blood circulation amounts are low. Carcinogenic structures require more blood than benign structures. Moreover, the blood flow rate is much increased compared to benign structures. The technique by which this situation is monitored is called Dynamic MRI. It gives the contrast retention rate of the structures detected in the breast.

PET: It is the preferred diagnostic method for many types of cancer that may develop in the body with radioactive labeling, especially in terms of detecting and monitoring their spread. PET, like MRI, is used to reveal that cancerous tissues are more nourished than normal cells. In this technique, radioactively labeled sugary liquid is given intravenously. It is diagnostic that this liquid is more retained by cancerous tissue and metastases, which have a higher sugar consumption, than the body. It is one of the advanced diagnostic methods. It is used to detect whether there is another focus and metastasis after cancer is detected in the body. In order for the examination to be most successful, the patient must go to the PET scan fasting. Since the tumor tissue will absorb more radioactively labeled sugar during starvation, the diagnostic ability and accuracy of the method will increase. PET, one of the advanced diagnostic methods, is applied only after the diagnosis of cancer is made. Benign structures in the breast do not have serious radioactive material retention, except in special cases such as infection. Cancer tissues and metastases will often show significant involvement compared to normal tissues.

COMPUTED TOMOGRAPHY: Since it gives a higher dose of radiation, it is preferred not for routine screening such as mammography, but for the recognition of indistinguishable structures, especially for the detection and follow-up of the spread of breast cancer in the body. While it can be used in annual screening for the brain, thorax and abdomen, the pad is also used to detail the structures detected and to name and diagnose them. For example: Lung, bone metastases..
Although benign structures do not give contrast with this technique, carcinogenic structures stand out with the intense contrast they produce.

DITI (Breast Thermalgraphy): The device does not emit any rays to the body, it is the process of detecting the thermal - heat rays (infrared) emitted from the body with the help of a special camera. Since it is highly sensitive to temperature, it can detect temperature changes in breast tissue even at a very early stage. However, it cannot show cell structures. For this reason, ultrasound is used as an auxiliary technique to evaluate the risk and potential for change of masses that can be detected by other techniques such as mammography. We mentioned that cancer cells need more nutrition and blood. This increase in blood flow to the tissue also creates a similar increase in blood flow and temperature in the projections of the tissues on the skin. The device detects the increase in temperature on the skin due to the reaction of the body, rather than the direct heat of the organ.

Benign structures generally do not cause any symptoms in Diti because they do not have a significant blood supply. Fibrocystic structures cause a slight increase in blood flow. Usually this is symmetrical as it occurs in both breasts. Precancerous structures show a greater temperature increase symmetrically. However, since no obvious structure can be detected in other techniques, the patient is closely monitored. Excessive and asymmetric temperature increases are considered highly suspicious for developing or developing structures. To understand the reason for this difference, further examinations should be performed and the patient should be followed closely.

LABORATORIES: Hemogram, CEA, Ca15-3, AST, ALT, GGT, LDH, CK, Alkaline Phosphatase, CRP, Sedimentation, B12

When making a diagnosis, laboratories are important in detecting the general condition of the patient, possible infection, hormonal pressure on the breast tissue, and symptoms of breast cancer.

Hemogram: It is important to show the general condition of the body and blood value. If mastitis, one of the benign diseases of the breast, is encountered, the hemogram is an important indicator of infection. The normal value of the number of leukocytes (resistance cells of the body) is around 7000. When this number exceeds 10,000-12,000, it indicates an obvious infection in the body. It also increases the cells called neutrophils, which the body develops against bacteria. If there is severe anemia, if the patient does not experience problems such as nutritional problems or excessive menstrual bleeding that cause anemia, and if there is a mass in the breast, the anemia may have developed due to carcinogenic cells. Especially in patients who are planned to receive chemotherapy, anemia must be treated as it will deepen further.

CEA: (Carcino Embryogenic Antigen) It is used as a general cancer marker in the body. Its increase indicates a carcinogenic change in the body. It is a chemical belonging to tissue. Since it occurs when tissues break down, it can sometimes indicate damage to organs. In order to differentiate, it is evaluated together with organ-specific chemical markers.

Ca15-3: Is a Breast Specific Chemical Marker. Its elevation along with CEA requires examination for diseases related to the breast, and its elevation during follow-up requires further examination as it may be significant in terms of recurrence or metastasis. It may show a limited increase seasonally and sometimes due to benign diseases of the breast.

AST - SGOT

ALT - SGPT

GGT - Gamma Glutamii Transpharesis

LDH

C.K.

These are Liver Function Tests. When the disease is detected, they are important both in terms of clarifying whether there is metastasis in the liver or not and in monitoring whether the liver is damaged due to the drugs given during chemotherapy.

Alkaline Phosphatase: Although it is among the liver function tests, it allows the detection of metastases that cause obstruction in the bile ducts of the liver, as well as the possibility of excessive darkening of bile and impaired bile flow during chemotherapy.

CRP: C Reactive Protein is the body's response to inflammatory and tumoral cell damage. Since it can be seen to be very high in rheumatic and inflammatory diseases, it is important to evaluate it together with other tests. If the body does not have any inflammatory problems, it is expected to be high. The high rate of cancer and cancer metastases is also striking.

Sedimentation: It shows the sedimentation rate of shaped elements in blood and serum. As with CRP, its elevation may be significant in terms of the body's microbial inflammations, inflammatory reactions, rheumatism and cancer. In some patients, it is recommended to regularly monitor the conditions that are detected to be high in repeated examinations for a long time. Sometimes it can be the first warning sign of a cancer that can be detected years later.

B12 deficiency Vitamin B12: It is absorbed by the internal agent secreted from the stomach wall, and its absorption is impaired in stomach problems. Many people may not know they have a B12 deficiency until it is too late. It is stored in the liver, kidneys and other tissues in the body. Therefore, a B12 deficiency may not occur for several years. Link between vitamin B12 deficiency and breast cancer: Without B12 and Folic Acid (Vitamin B9), DNA cannot be maintained, cannot divide normally and healthily, but can break down to the point where mutations – and cancer – can occur.

**When breast cancer is diagnosed, it is one of the first markers that are examined and corrected when breast cancer is detected.

Surgical Diagnostic Methods

Biopsies

Fine Needle Biopsy
Trucut Biopsy
Stereotactic Biopsies
Vacuum Biopsy

Incisional Biopsy
Excisional Biopsy